Category Archives: Care

Post navigation

by Samantha Schnobel

Describing a veterinarian’s professional duty, Bernard Rollin dichotomised the role placing at one end a garage mechanic and and at the other, a paediatrician. Simplistic in design, this analogy gives us pause to consider the ethical and legal duties of care stemming from the triangular relationship created between animal, veterinarian, and owner. Within this triangular relationship, deeply meaningful, bi-directional relationships can occur between animal and owner. An integral part of the veterinarian’s role, therefore, is not simply about animal health (though this is certainly a primary concern), it is also about preserving and fostering the animal-owner bond. In a very important way, then, veterinarians are the final arbiters not only of animal health, but also the caring relationship shared between owner and animal. Expanding briefly on caring relationships within the triangular relationship just discussed there will almost always be a relationship of care between owner and animal. In the first place, the owner, by the act of bringing the animal to the veterinarian in the first place, is exhibiting caring behaviour. Beyond this, the animal is almost wholly dependent on its owner for the basics of life (ie. food, water, shelter, etc.) and the fostering of basic capabilities, which animals experience (ie. emotion, imagination, etc.). Also, by virtue of the veterinarian’s aesculapian position, caring relationships can also be said to exist between owner and veterinarian and veterinarian and animal. Having said that, complications can arise where, for example, the veterinarian is engaged in alleviating the suffering of the animal only to obtain payment of fees. The existence of this incongruous model of veterinary care is arguably what led Rollin to describe a veterinarian either in terms of a paediatrician or a mechanic. Unfortunately, as the below will discuss, the law has played a significant role in forwarding a framework which restricts the development of a more care-based model and rather supports an instrumental view of the veterinarian’s role. The position I take throughout this discussion is that the law should seek to promote a construction of the veterinarian’s duty which supports a much stronger, relational approach.

Currently, then, from a legal perspective, the Cartesian example analogised by the garage mechanic is most accurate. Here, the duty of care is owed solely to the owner and the veterinarian is charged with repairing a mere, commodified “thing.” In essence, the law treats the animal patient no differently than a car, or a table, or any other piece of property. No weight is placed on the relationship shared between animal and owner or the animal’s individual sentience. Instead, the focus is placed on the commercial relationship between veterinarian and owner. Thus, if the treatment is negligently completed, monetary damages can be awarded which would allow the claimant-owner to buy a brand new “thing” of equal value. Because many animals lack a sufficiently high market value to make a professional negligence claim viable, very little attention has been paid to the legal duties of care owed by veterinarians [1]. If, however, courts could be persuaded to make the evolutionary step and acknowledge that an accurate characterisation of the legal relationship between owner and animal is not to be found in the base conception of owner and disposable/replaceable property, but rather more accurately as something far more complex and meaningful, veterinarians could face a considerably higher level of professional scrutiny, particularly at the duty of care stage. In light of several recent stories involving potentially criminal and negligent conduct in the execution of veterinary services, discussion of legal duties of care becomes increasingly important [2].

Current veterinary negligence case law⎯ of which there is admittedly very little in comparison to other analogous professions⎯ disregards an in-depth duty of care assessment, focusing instead on the economic loss sustained by the owner and the breach of duty analysis, which relies heavily on specific factual analyses. The duty aspect is largely forgotten, finding simply that a duty to act reasonably in the given circumstance existed. Such an approach is consistent with an economic theory of negligence which focuses on liability costs, an entrepreneurial economy based on freedom of action, and efficient settlements. What this theory leaves out, however, is the relational aspect both between owner and veterinarian, but also owner and animal, and owner-claimant and judge. According to West and Oliphant, it is adherence to the pursuit of legal certainty and economic efficiency which leads not only to injustice and incoherence, but also a time-frozen, rigid body of jurisprudence, out of touch with prevailing social standards. West’s work in particular focuses strongly on the often-neglected role of feminist and caring theory in tort law and advocates a strongly relational approach not only for judging cases, but importantly in understanding the relationship between all concerned parties. Lastly, by neglecting the duty of care assessment we lose out on discussion related to how a veterinarian ought to act, as opposed to simply how one did act; thus, much of the normative force behind negligence jurisprudence is lost.

To be preferred is an in-depth analysis at the duty of care stage which focuses on the relationship between the owner and the veterinarian. According to Goldberg and Zipursky and McBride, the duty of care analysis is inherently relational with more onerous and affirmative duties (i.e. the duty to protect against emotional harm and the duty to rescue) attributed to those instances where a strong, pre-tort relationship exists [3]. Importantly for veterinarians, this type of analysis more effectively guides human contact, better preserves respect for the law and better integrates law into a variety of professional settings (Goldberg & Zipursky, 1998). Further, adopting the relational perspective for duty causes individuals to focus on particular aspects of others‘ well-being and to develop an ‘internalised normative pull towards certain sets of actions’ (Goldberg & Zipursky, 1998: p.1831). It is this type of discourse which is sorely missing in veterinary negligence case law and literature.

Building from the above, I would argue that similar to human medicine, veterinarians owe many duties of care stemming from positive acts and omissions. More specifically, duties could stem from treatment and diagnosis, disclosure of risk and duties to warn. Where there is a strong pre-tort relationship, there may be duties to rescue and duties to protect against the infliction of emotional harm. When this is combined with concerns with for the animal patient, difficult situations arise for which veterinarians have either very little guidance [4], or inaccurate guidance.

In order to effect meaningful change in this area and provide veterinarians with a more clear sense of their legal duties, I would argue, following Oliphant and West, that the mechanical application of rules and insistence on institutional consistency⎯ especially those relating to a law and economics perspective⎯ should be rejected. In its place, the judiciary should adopt a duty of care analysis based on the identification of relevant factors derived from a holistic, compassionate assessment of individual cases, paying particular attention to the nature of the relationships between veterinarian, owner, and animal. It is only through this type of high-level analysis based on underlying values and fundamental principles relating to our duties to others that conduct can be shaped and the interests of all parties can be given more meaningful consideration. To what extent the ethic of care could inform development in this area is thus a legitimate and thought-provoking question warranting greater attention.

Samantha is a doctoral candidate and teaching assistant at the University of Birmingham. Her primary research interests lie in the fields of professional negligence and ethics, specifically in the areas of human and nonhuman medicine. Her doctoral research focuses on the legal and ethical considerations pertaining to the duty of care in human and non-human health-related negligence claims. Additional research interests lie in animal welfare and property theory, in particular sentient property and the interaction between property and personhood found in the work of Margaret Radin

[1] In a negligence claim, it must be established that the defendant owed the claimant a duty of care. This is in addition to damage (ie. property or personal injury), fault, and causation. Essentially, the duty of care question asks whether the defendant owed the claimant a duty to take reasonable care to avoid or protect her from the type of harm suffered.

[3] This type of relationship could be said to exist where, for example, the veterinarian has served as the animal’s veterinarian for a specific condition for some time prior to the alleged tortious incident.

‘Peripheral thinking’ seems to me to be one useful framework for identifying what states do when they respond to residents’ practices of travelling away for care. States take a variety of actions when their residents cross borders for care; actions which produce, stigmatise, ease, regulate and represent that flow all at the same time pulling it in different directions. If we want to understand better the effects of those actions and perhaps even how to steer them, we need a way to differentiate between them while acknowledging the transnational space they occupy. Here I want to distinguish between three different kinds of peripheral thinking that inform such state actions – inverted, tangential and circular – in order to consider further how best to respond to the spaces for engagement that they open up. My reflections work out from the example of state actions and transnational care flow with which I’m most familiar, that of Irish state practices as they contribute to women’s outward flow for abortion care (Fletcher, 2013).

Inverted peripheral thinking

When states adopt law and policy that support travel for care whose provision is restricted at home, one kind of peripheral thinking they use to justify their actions takes an inverted form. They claim that the failure to provide the particular care at issue is actually evidence of a central role in international care provision and not a peripheral role. In arguing that Ireland is an international leader in care for the ‘unborn’ and in maternity care more generally, the state has often represented its failure to care for pregnant women as a success. This is a familiar if crude form of thinking, which Barrett (1992), drawing on Marx, called the ‘camera obscura’ version of ideology. The periphery represents itself as central to the delivery of care (to the ‘unborn’), with the effect of negating a peripheral role and obscuring failures in care delivery (to pregnant women).

Tangential peripheral thinking

But inverted peripheral thinking is not the only rationality that states use when they play a role in generating outward flows for abortion care. They may turn authoritarian in restricting or punishing travel for abortion care (Fletcher, 1998), but that is relatively rare. It is more usual for states that are peripheral to the provision of abortion care to end up accommodating use of that care to some extent because their residents compel them to. In the 1990s the Irish state famously compromised on its anti-abortion position by constitutionally recognizing freedoms to travel to and receive information about abortion care abroad. Since then the Crisis Pregnancy Programme has developed a network of predominantly pro-choice counselling agencies throughout the Republic of Ireland which provide free pregnancy counselling and post abortion check ups.

In a two-tier health system where many people pay fees to attend a general practitioner, the provision of free pre- and post- abortion care, with all its limits, is significant. In using regulatory techniques such as public funding, training and communication to normalize travel for abortion care, the Irish state demonstrates tangential peripheral thinking. Here the peripheral thinker does not want to become core as care provider, but instead approaches the core provision of abortion care sideways. Peripheral thinking develops tangential connections with the core provider of abortion care by taking on activities which are a key part of abortion care, but are themselves on the periphery of that care, namely the provision of information, counseling and check ups. Tangential peripheral thinking then is conscious of being at a distance from core care provision, and does not want to become core. Rather tangential thinking connects periphery and core care providers by taking peripheral care activities, which are needed for the provision of core care, as the object of its attention and facilitation.

So far, civil society critics of Irish abortion policy have focused on the discriminatory and hypocritical aspects of this kind of tangential thinking (e.g. ARC, CRR, DfC, ICCL, IFPA, WHRA). Travel policy has discriminatory effects and is not an adequate means of the state meeting its public responsibilities, because the less mobile will be less well served. Abortion travel policy is hypocritical because it cedes its domestic anti-abortion moral stance and supports access to abortion on grounds that would not be legal within the territory. But these critiques can retain their truth while we also recognize that travel policy has some positive effects from a feminist perspective.

We can welcome the way that this public recognition of women’s use of abortion care has likely contributed in some way to increased tolerance of abortion. Opinion polls now regularly reveal greater levels of support for abortion than the state is willing to entertain in domestic provision. Although, as in many other countries (e.g. Sanger, 2014), Irish women are far from feeling free to speak openly at will about their abortion experiences, there have been several initiatives which tackle the association of abortion with stigma in the public sphere (Enright, 2014). The state’s tangential peripheral thinking has opened up (and indeed arguably resulted from) spaces for feminists and pro-choice advocates to engage and push the state further towards recognizing and serving women’s needs.

Circular peripheral thinking

A third kind of peripheral thinking that we see in Irish abortion travel policy takes a circular form and argues that there is nothing the state can do to change its own practices. Here the state argues that its own rules, or the views of the people, prevent it from acting to cure some harm or wrong that it cedes is in contravention of international human rights norms. There was a particularly spectacular example of this kind of peripheral thinking evident in the state’s response to the UNHRC during Ireland’s review under the ICCPR in July 2014. The Minister for Justice and her staff faced hard-hitting criticism by the HRC members for the failure to protect women’s civil and political rights in relation to abortion but also more generally (e.g. Cahill, 2014).

Representatives of the Department of Justice responded by relying on Article 25 and the right to vote to say that past abortion referendums meant it could not do any more legally to bring Irish abortion law into conformity with the Covenant. As Enright tweeted during the hearings (I’m paraphrasing), “to recap, the Department of Justice has just argued that Parliament can vote to inflict inhuman and degrading treatment on women”. Much was made at the time of this failure of the state to recognize that this ‘tyranny of the majority’ type argument contradicted the whole premises of the state’s claimed commitment to human rights, and indeed HRC member Mr Shany asked the state party to withdraw the relevant statement.

But here the point I want to make is that this way of thinking is a circular denial of sovereign power to make and interpret law. This state is so embedded in the periphery of abortion care that it can’t even imagine the possibility of proposing a referendum which would liberalise abortion provision, rather than restrict it (see further Flinterman’s comments). A state which refuses to act in legislating for abortion care (except when forced to by the ECtHR in ABC) on the grounds that its own legal rules so prevent, or that the people would not tolerate such action, has a strange understanding of its own legal power and moral responsibility.

In representing itself as a passive effect of its own legal authority, the state adopts a circular form of peripheral thinking which renders it eternally peripheral to its own power in a spectacular act of legal misrecognition. Of course, the state could introduce a Bill to remove Article 40 3 3. It could decriminalize abortion. It could promote an interpretation of Article 40 3 3 that recognizes substantive differences between pregnant women and fetuses, and permits domestic abortion in a way that would likely reduce the outward flow. But it chooses not to.

Conclusion

States, particularly the Irish state, have actually been quite creative in responding to their residents’ practices of travelling abroad for care that is restricted at home. They have used a range of regulatory techniques that have effects on cross border care flows. In the case of law and policy on abortion-related flows, these different techniques present challenges and resources to those of us who wish to make abortion access easier. First of all, we need to throw our net more widely when we try to capture legal tools that have an effect on women’s abortion practices. The legal instruments which restrict women’s access on the territory of the nation-state are significant. Inverted peripheral thinking, which denies harms to women while celebrating care of the ‘unborn’ as a marker of international leadership, arguably takes care and international norms seriously, but requires redirection.

But as women’s cross-border abortion practices illustrate, norms of domestic restriction are not the only legal instruments that are significant. Regulatory measures that promote non-judgmental information and counselling and provide public funding do acknowledge extra-territorial abortion use and attempt to reduce harms to travelling women. Working with such tangential peripheral thinking may provide further opportunities to destigmatise abortion and promote a harm reduction framework. And finally, the kind of circular peripheral thinking, which sees the state deny its own power to have an impact on care flows, provides welcome opportunities for reminding the state that women are not the only ones who bear public responsibilities for care provision.

PS I wrote this before the news of the recent abortion refusal case broke. My initial thoughts on that failure in abortion care are here: http://humanrights.ie/constitution-of-ireland/contesting-cruel-treatment-ruth-fletcher/

If you would like more information about civil society’s campaigning responses to this case and more generally please see: http://www.abortionrightscampaign.ie and https://www.facebook.com/pages/Speaking-of-Imelda/571659212932533

I have been working in education and social care for thirty years, and have seen various new initiatives and buzz words come and go, whilst the fundamental principles of humanity remain the same. ‘Co-production’ in its truest senses is grounded in these principles. However, as with the concepts of ‘personalisation’ and ‘reablement’, there is a real danger that the term ‘co-production’ is misused for hegemonic purposes to cover up what is essentially a cost cutting exercise. Under this scenario, individuals and their communities are expected to take on more responsibility for their own well-being whilst the machine of impersonal and ‘professionalised’ public services carries on as it always has done, albeit it with a few less staff employed. In my opinion, this would be a travesty and missed opportunity to restore warm humanity as the driving force for public services, not compliance with increasingly centralised and de-personalised processes and systems.

One of my favourite quotes by the theologian Martin Buber is ‘all real living is meeting’. Please note that Buber’s understanding of the term ‘meeting’ is much richer than the idea of putting a group of people together in a room or placing nurses and social workers in the same office, which is commonly assumed to result in integrated practice. I am sure many people will share my experience of being in meetings where no one actually met, where each person had their own agenda and the purpose of the meeting was to get this across – to win the argument. For Buber, ‘meeting’ is about genuinely connecting with other people and being changed in some way by the process. In order to explain this process, he talks about two ways of relating to people and the world, which he calls ‘I-It’ and ‘I-Thou’.

In ‘I-it’ relationships, the person is detached and unaffected. In ‘I-Thou’ relationships, the person is attached and vulnerable. Tom Kitwood, in his seminal book ‘Dementia Reconsidered – The Person Comes First’ talks about his experience of seeing how people living with dementia were dehumanised through receiving emotionally detached task based care:

‘A man or woman could be given the most accurate diagnosis, subjected to the most thorough assessment, provided with a highly detailed care plan and given a place in the most pleasant of surroundings – without any meeting of the I-Thou kind ever having taken place’ (Kitwood, 1997)

By contrast, I believe that genuine co-production facilitates and nurtures the development of ‘I-Thou’ relationships between all parties, which in so doing begins to challenge the prevailing understanding of professionalism and professional boundaries. In relation to this, I am currently co-ordinating a NISCHR and Joseph Rowntree Foundation (JRF) funded project in Wales, which is focused on the use of evidence from their ‘A Better Life – for older people with high support needs’ programme, along with other forms of evidence in social care service and workforce development.

The ‘A Better Life’ programme has identified that relationships are key and ‘Often it is the simple things that bring the most pleasure (and the lack of them can bring a sense of sadness and loss) and services do not always seem to be very good at delivering ‘the ordinary’’. (Blood, 2013 p13)

The research challenges also call for a different way of working, which is often alien to the world of emotionally detached and compliance focussed task based care, which is summed up nicely in the following quote by Edgar Cahn:

‘The world of helping others in need is now built around one-way transactions…. and with the best of intentions, one-way transactions often send two messages unintentionally. They say: “We have something you need – but you have nothing we need or want or value.”’ (Cahn, 2004).

In a series of recent focus groups and learning events involving older people, carers and frontline staff, I have been struck by how many people feel that current regulation and guidance is risk averse restrictive and at worst destructive of human relationships. For example, workforce regulation states ‘the inappropriate use of touch is not permissible’, rather than ‘the appropriate use of touch is fabulous and to be encouraged’. This is a particular issue for people living with dementia, who often have to express themselves and connect with others through feelings and emotions. Frontline staff talk have talked about feeling guilty when they do little kind things that are not written in the Care Plan or receiving small gifts of appreciation, older people have been ‘told off’ (in the name of health and safety) for pouring tea for others in day services, and carers have been made to feel that they no longer have a role when the person they love goes into a care home.

At the heart of co-production, is an understanding that everyone has something to contribute and that exchanging these contributions is enriching for everyone concerned. I am reminded of the work of Jean Vanier, who established the L’Arche Communities in learning disability services. Vanier did not see his role as caring for people with learning difficulties, but rather sharing his life with them and being open to receive and learn from them as much as to offer them support.

I am reminded of one of my earliest experience of working in social care services. It was 1984 and I had started my first job as a residential support worker in a children’s home. I thought I was the ‘sorted one’ who was employed to help others. I worked hard to form good working relationships with staff and children in the home, but one boy, who had experienced a lot of hurt in his life, kept his emotional distance. As anyone who knows me well can tell you, I am not gifted in DIY or anything that involves fixing something mechanical. One day, I was trying to repair my bicycle (I did not drive at the time) and was getting nowhere fast. The boy walked past me and said ‘I’ve got a book about repairing bikes, do you want to borrow it?’. I am pleased to say that I took up his offer and our friendship took off from that day. He is now a happily married 43 years old who lives on the other side of the country, but we still keep in contact via Facebook and phone and offer each other support and encouragement whenever we can.

Jean Vanier once said, ‘I am struck by how sharing our weakness and difficulties is more nourishing to others than sharing our qualities and successes’. This is an important message for social care practitioners and agencies. We need to open our ears, our eyes and our hearts to the people we work with, which might involve sharing our vulnerabilities and concerns and allowing ourselves to be changed by genuinely ‘meeting’ with them in truly co-productive relationships.

There is a lack of specialist domiciliary care for older LGBT people, with the exception of Pride in Care UK. Many older lesbians and gay men in particular re-closet themselves in their own homes, for fear of prejudice from carers (9);

There is a lack of services to support older LGBT in setting up housing cooperatives where they provide one another with reciprocal support and/or buy in care which is respectful of, and meets, their needs.

As a result of these unmet needs, older LGBT individuals are left with a stark choice: ‘the prospect either of living alone without support or having to enter [sheltered housing and] care homes which will not meet their needs.’ (10) We say ‘it gets better’ to younger LGBT people. And for many that may be true. But the sad the truth is that in older age it gets worse. As much as we should address the needs of LGBT youth, we also need to address the needs of older LGBT individuals as well. Schools are a problem for LGBT youth. Sheltered housing and care homes are a problem for LGBT older people. We must tackle both.

A few moths ago, I attended a seminar on infertility treatment. The audience included those involved in infertility treatment, academics, practitioners, and interested others. The complexities surrounding infertility treatment are vast and range from the very intimate and personal to legalities at national and international level. Conducting research in such a sensitive area is fraught with difficulties and the speakers were all very aware of the ethical implications of their research and practice. I was particularly interested in the researchers’ experience of accessing and interviewing men. The general view in infertility studies has been that men are not interested in participating in research, and many studies are heavily weighted with female respondents. As one researcher described her many efforts to interview the male partner of a couple, a ripple of sympathetic recognition of her struggle arose from the audience. ‘Typical man’ seemed to be the collective verdict, mine included. As I reflected back on the day I returned to that incident. The audience reaction was one of sympathy for the researcher and I wondered if that man did not also deserve some empathy. I know from my own research that many men assume that they will be fathers and that that knowledge is so embedded that it is not discussed. The assumption expressed has been that one would leave school, get a job/go to university/ get a job, find a partner, find accommodation, have children. That being the case I tried to put myself in that man’s position: the assumed ‘natural’ event had not happened. How would I feel? Shocked to the very core? I think so. Perhaps I had been brought up not to show feelings and instead, to show control – ‘mastery’ – through actions and/or rationality. In which case my reactions may include striving to balance things up by working and playing harder, or not becoming involved. Being raised in an environment where I am not expected to express emotions, I possibly, do not have the confidence or vocabulary to verbalise my emotional state. Here are my musings on what may have been ‘going on’ if I was that unwilling participant, “So, here I am, not fulfilling the role I expected to – and that others seem to achieve with ease – and I cannot make it right. There is only one person I can talk to and that is my partner but it is worse for her and the one thing I can be is strong for her. Then there is this University researcher who wants to have a talk. She’s talked to my partner, and wants to talk to us both. My partner thinks it will do me good. I don’t know how to express these feelings inside without bursting. I want to support my partner, part of me thinks it would be good to release the emotions but I can’t risk overwhelming her in the way I am sometimes overwhelmed. I’ll say I’ll do it and then see.”
If the participant’s thoughts and feelings were similar to the above then it is understandable why he was ambivalent about being interviewed.

Infertility has been seen as a form of complex bereavement consisting of multiple loses (Adler, 1991; Lechner et al., 2007) with levels of distress in women recorded as high as those suffering from serious medical conditions (Domar et al., 1992; Domar et al., 1993). However, recent research shows that, post infertility treatment, men who did not become fathers suffered poorer mental health than those who had become fathers (Fisher et al., 2010). In their conclusions Fisher et al (p.6) state ‘…that stereotypes that infertile men conflate fertility and masculinity, are less distressed than women about potential loss of parenthood, and adjust more readily to childlessness appear inaccurate.’ Men may or may not be ‘typical’ by choice but there are many social factors that influence their behavior and how their behavior is perceived. The belief that men are not interested in taking part in research, and their absence ‘condemned to be meaningful’ (Lloyd, 1996: p.451), reflects a lack of insight by the research community. I feel I must stress here these are my own reflections based on my research on involuntarily childless men and not a particular person or persons.

Those of us who share our lives with dogs know that interspecies relationships are an important and mutually enriching basis for caring practices, yet it is also evident that dogs are often victims of a complete lack of care. These extremes of care are vividly captured in the contrast between the casual cruelty of the 27 year old trainee solicitor sentenced to 18 weeks in prison last month for leaving her boxer dog to starve in a locked kitchen, and the tenacity with which homeless people cling to their relationship with their dogs notwithstanding the difficulties this may pose to them in finding a home. Paradoxical attitudes also characterise media responses to dogs. At the same time that television programmes celebrate The Wonder of Dogs, newspaper reports disproportionately depict dogs as out of control weapons or feral killers. In a familiar litany of reporting of dog attacks on humans, common features are a focus on breed, a desire to impose responsibility and a failure to address the root causes of our problematic relationship with dogs. Over the last few months this is evident in accounts in February 2014 of dog attacks in Blackburn, where an eleven month old girl, Ava-Jane Corless, was savaged as she slept in her bed by an American pit bull type dog owned by her mother’s boyfriend, in Carmarthenshire where Eliza-Mae Mullane, a six day old girl, died having being pulled from her pram and bitten by her family’s Alaskan Malamute who had been acquired from someone in a pub, and in Lincolnshire where in March another pit bull type attacked a 22 year old woman walking near an old quarry.

Malamutes and bull breeds figure disproportionately amongst the sheer numbers of unwanted dogs that are stretching the resources of local authorities, charities and dog rescues. The 2013 Annual Stray Dogs Survey by Dogs Trust reveals that 111,986 stray and abandoned dogs were picked up across the UK over the last 12 months, equating to 307 stray dogs being found every day. Many are bull breeds, victims of a process of media stereotyping fuelled by the 1991 Dangerous Dogs Act which in categorising pit bull terriers as dangerous dogs, has served to make all bull breeds perversely attractive to the wrong sort of owner. One particularly tragic case highlights the potential for well intentioned and caring actions to go wrong in the world of dog rescue. In November 2013 four year old Lexi Branson died after being mauled by her family’s dog Mulan. According to newspaper reports Lexi’s mother, Jody Hudson, fatally stabbed the dog in a frantic attempt to save her daughter when he attacked her on the floor of the lounge in their flat. It transpired that Mulan was an American bulldog type who had been adopted by Lexi’s mother in August 2013 from a Leicestershire rehoming centre. The rehoming reportedly took place after she had seen a picture of the dog in the rehoming section of the rescue’s facebook page. A friend of Ms Hudson reported that the dog had a soft nature and that Ms Hudson had been told he was safe around children. The rescue declined to comment. In the absence of all the facts it is important not to judge actions, as anyone involved in dog rescue will testify.

I volunteer with one of the many small dog rescues struggling to cope with Britain’s unwanted dogs. We work closely with a local authority pound in the North West of England to provide emergency kennel space for dogs who have not been reclaimed, rehomed or offered a rescue space within seven days. At this point they can lawfully be humanely destroyed under s 149 Environmental Protection Act 1990. A key aim of organisations like ours is to place our dogs with bigger and better resourced rescues. However, typically, due to their fear of being overrun with too many unwanted breeds, it falls to smaller rescues to rehome bull breeds – mostly Staffordshire Bull Terrier crosses. We homecheck for our dogs as carefully as possible, requiring prospective owners to complete forms, submit to a home visit, visit the dog in kennels and ensure that dogs are neutered and vaccinated prior to rehoming while dogs are not placed in a home with children under 10 years old. However a consequence of such conditions is that we lose out on good potential homes and in many cases prospective adopters will simply buy a puppy or adopt from a rescue too stretched to impose such conditions. And notwithstanding the care taken and great joy of waving a dog off to a new home, the process is inevitably accompanied with apprehension that things may go wrong, given the difficulties of adequately assessing dogs in a kennel environment.

However in the absence of the full story in most of these cases there are nevertheless a number of conclusions we can draw about media reporting and the reaction it has provoked which serve to highlight our flawed thinking about dogs. Initial media reports of the Branson case pictured Lexi with her uncle’s Dogue de Bordeaux who was erroneously deemed responsible for the attack and wrongly described as a French mastiff. The upshot was that breed specific rescues were reported in dogworld as having been inundated with calls from concerned owners wishing to give up their dogs. When pictures of Mulan were published, the immediate response of bull dog rescues was to deny that Mulan was a ‘British bulldog’, with an editorial in dogworld opining that “After some initial confusion, the dog responsible for this incident is now referred to as a bulldog even though it bears little resemblance to the pedigree Bulldogs bred in this country.” Such responses strike me as reflecting the manifold failures of social attitudes including UK law which casts dogs as disposable commodities and indiscriminately stigmatises certain dogs purely on the basis of their morphology or breed type. Media narratives which reify this focus on breed, and implicitly criticise the irresponsibility of a mother in choosing to allow into her home a dog of uncertain pedigree and origin, or rescues which somehow failed in an ill-defined area, obscure the root causes of indiscriminate breeding which produces unhealthy or ill socialised puppies, dangerous dogs legislation which has compounded the problems of unwanted and often traumatised bull breeds and a legal strategy of ascribing responsibility for stray and unwanted dogs to local authorities which are already struggling to fulfill their core responsibilities and are ill equipped to cope with the complexities of dealing with stray and dangerous dogs. Against this backdrop blaming a mother for her caring action in adopting a dog in need of a home, a not for profit organization struggling to fill the gaps in state provision or even the dog himself is manifestly ill conceived. Until our outdated and paradoxical legal attitudes to dogs are tackled, tragedies such as these unfortunately seem unavoidable, however much well intentioned individuals and dog rescues strive to care.

In a recent blog-post Donatella Alessandrini discussed the ”Wages for housework” campaign, referring to its main activists, among them Selma James. It seems that, when struggling to solve the problem of valuation of care and subsistence work, there is much to learn by revisiting the work and good thinking of feminist pioneers decades ago. I have recently had the pleasure to revisit another pioneer, Marilyn Waring and her critique of the system of national accounts in Counting for nothing/If women counted, originally published in 1988.

With the late Professor Ailsa McKay, I have co-edited an anthology on the impact and resonance of Waring’s groundbreaking work a quarter- century later. The resulting collected volume, Counting on Marilyn Waring: New Advances in Feminist Economics, published by Demeter Press, Canada, March 2014, maps new advances in theories and practices in feminist economics and the valuation of women, care and nature since Marilyn Waring’s Counting for nothing. The breadth and range of topics and perspectives covered in the anthology highlights the impact and endurance of Waring’s work, in the shaping of the discipline of feminist economics and in influencing women’s lives across the globe. In the foreword to the collection Professor of economics Julie A. Nelson, University of Massachussetts, Boston, points out how Marilyn Waring’s If Women counted ”encouraged and influenced a wide range of work on ways, both numerical and otherwise, of valuing, preserving, and rewarding the work of care that sustains our lives”. At the same time, Waring’s original critique of the system of national accounts for ignoring the value of care and subsistence work is still sadly relevant. Despite the development of feminist economics as a field of academic research and activism over the past decades, economic policies are still informed by economic theory and models that ignore the value and importance of care and that of Nature. The book is a contribution to the continued struggle for valuing care as well as an attempt to bring the field forward.

The publication of the book sadly coincided with the death of my co-editor, Ailsa McKay, who passed away, far too early, at the age of 50, on 5.March. Ailsa was herself a pioneer in feminist economics. She was Professor of Economics at Glasgow Caledonian University, and a founding member of the Scottish Women’s Budget Group. She combined her role as a renown academic and a leading authority on gender budget analysis with a strong community involvement for change. She has had a lasting impact on the field of feminist economics and the struggle for valuing care.

As an irony of fate, illustrating the persistent and recurring devaluation of care and motherhood, our publisher, Demeter Press, now struggles to stay in business, after being denied a much needed and anticipated government publishing grant. The argument was that its focus on mothering and motherhood was a liability, and that it needed to broaden its focus. Demeter Press has just launched a fundraising campaign. Hopefully many will support the only publishing house dedicated to publishing on motherhood and mothering.

The ‘Minding the Knowledge Gap’ ESRC funded seminar series held its fourth seminar at the University of Surrey last week. This seminar, called ‘Counting the Costs? Resources, Austerity and Older LGBT People’ addressed the material, financial and social resource implications of lesbian, gay, bisexual and trans (LGBT) ageing, particularly in times of austerity. It was well-attended by participants from a range of backgrounds: LGBT individuals (in all their diversity, including some in older age); advocates and activists; academics; social policy makers; and the police. There were two speakers. Dr Noah Uhrig, from the Institute for Social & Economic Research, University of Essex, gave a fascinating talk on ‘Poverty and Material Well-being of LGBT elders’, somehow managing to make some very complicated statistic not only accessible but also enjoyable. Audience members gazed in avid fascinating and still wanted more at the end. The second speaker, Dr Martin Mitchell, NatCen Social Research presented on ‘Not just “a nice thing to do”: Marginalisation and hardship for LGBT older people in the context of austerity cuts.’

Noah spoke of recent research project on poverty and sexual orientation (constrained by the usual problems with representative sampling of a ‘hidden population’) which suggested significant material differences in later life for LGB individuals compared with heterosexual individuals, and between one another. A key feature was the suggestion that older lesbians were materially advantaged compared with both older heterosexual individuals and older gay men. Noah’s data – which he bravely presented, anticipating the response it would meet – were, not surprisingly, hotly contested by many of the lesbian members of the audience. They found the idea of older lesbian material advantage counter-intuitive. Discussions raised issues of: women’s relative lower earnings to men; women’s greater representation in (lower paid) public services work, especially care work; women (including lesbians!) taking time out of work to have children, and to perform other informal unpaid care work (including for parents and grandchildren); women being much more likely to be in part-time paid work (rather than full-time work) while also performing unpaid informal care work (1). Noah acknowledged the tensions provoked by the data, and plans on conducting further analyses. We look forward to hearing more!

Martin then spoke of the double-edged sword of austerity cuts. Older LGBT individuals are more likely to need support from those public and voluntary sector services (health and social care, informal and formal social support) which are currently subjected to drastic cuts in funding (2). Those cuts in services impose increased pressures on an already pressured cluster of minoritised individuals, meaning they have a greater need for services, at the very time when there are fewer services available. Lack of material and social resources have profound implications for the well-being of older LGBT individuals (3) (4).

Afternoon discussions returned to the issue of gender (again unsurprisingly) and to the need to continuously unpack the ‘LGBT’ acronym (5), to appreciate how older lesbians, gay men, bisexual women and men, and trans individuals are particularly affected by the material and social resource implications of later life. The plight of the Opening Doors London project, supporting 1,000 older LGBT individuals in the London area, and which has lost all of its funding, highlighted the lived realities of the implications of austerity cuts. Towards the end of the day two distinct responses to resourcing projects for older LGBT in later life: the neoliberal model of private and national state engagement; a more localist, communitarian approach involving local LGBT groups and local government. It was mentioned that in Australia and some parts of the USA, older LGBT have been designated a ‘special needs group’ (with all the complications of such a categorization) and as such are eligible for state funding for local projects.

Much food for thought, and much work to be done, but all-in-all, it was a stimulating and thought-provoking day, made so by the contributions of all who attended.

It has taken me three months to finish reading Yasmin Gunaratnam’s most recent publication, Death and the Migrant -a collection of accounts of transnational dying and palliative care in English cities. It wasn’t overly long or complex, nor was I lacking in the time to devote to its reading. It took me three months to read a hundred and sixty one pages because every time I encountered a narrative from a care practitioner or a dying person, I also found myself reflecting on the time that I have not spent listening to those around me.

I can honestly say I cannot remember the last time I gave someone the justice of letting them speak without me interjecting. As Prue Chamberlayne has shown in her discussion of using biographical narrative methods with ‘Laura’, the manager of a homeless hostel, there are often long biographical trails behind those who work in the caring professions that can affect their capacity for ‘emotional thinking’ and listening to difficult stories.

Let me give you some background about myself – when I was six years old, teachers became increasingly frustrated with me not ‘doing as I was told’ and not learning at the same pace as other children in my class. It turned out that I had glue ear (a condition where your inner ear becomes filled with fluid), which stunted my listening and learning capabilities. Ever since then I have made a subconscious effort to make up for lost time.

I am the talker, the socialiser, the comedian, the anecdotal storyteller. It is because of these traits that I have fallen into a caring profession. I work with vulnerable people who are homeless and I try to provide them with support to maintain their independence and help them to develop and/or refine their life skills.

I cannot remember the last time that I was with a homeless person and just let them speak and tell me their stories. Any information that I tend to know about them is generally gleaned from case notes or instrumental questions that will help me to deal with their current problems. I couldn’t really tell you what their life has been like and from their own personal perspective. I don’t know how they felt at the height of their troubles or what their most memorable life events are. I can’t say that in all my years of working in the charity world I have been privy to any poignant childhood memories that I have helped to elicit.

In the support work field, we are part of a paradigm of holistic care, which means that services make a point of taking the ‘whole person’ into account before making a diagnosis of what support and care can be offered. Having read Death and the Migrant, it seems to me that it is narratives and stories that are missing from my profession. If I listened wholeheartedly, unabashedly and sincerely, perhaps I could provide truly holistic support to those I want to help. This is more than suggesting the value of incorporating narrative skills and knowledge into the development of a package of care, it is also thinking about listening to stories as care. Might skills in eliciting and listening to the stories of others reconfigure the balance of complex emotional relationships between the listener/professional and storyteller in ways that validate the vulnerable ‘other’?

Excuse the cliché, but perhaps it is time for me to sit down and let someone else do the talking…

Arooj Khan is the Mentoring and Befriending Project Coordinator for Housing Justice. She is a Goldsmiths College postgraduate student with an interest in service delivery models for homeless individuals. She can be contacted via LinkedIn or at Housing Justice, 256 Bermondsey Street, London, SE1 3UJ

Share this:

Concerns abound regarding the social, political, economic, and individual changes necessary to care for a growing population of older adults experiencing physical and cognitive decline. These concerns are evident in academic scholarship, with a large body of research advancing theory and practice on caregiving and receiving in later life. Despite this focus on older adults, however, the ways age relations frame experiences of care are not clearly articulated. The concept of age relations, which owes much to the work of Toni Calasanti (e.g. Calasanti, 2003, 2006), considers the structured social relations that frame interactions among members of different age groups. Age is relational because one’s membership in an age group is defined in relation to other age groups, and because membership in these groups forms the basis for access to, or exclusion from, various rights and privileges. Inequalities among age groups intersect with other power relations associated with gender, class, and race/ethnicity. In this blog post I outline three ways theorizing age relations might move forward perspectives on later life care.

First, theorizing age relations helps to understand how care for older adults is conceptualized differently than care for people in other age groups. Feminists have long recognized that patriarchal conditions diminish the value of caring for ‘dependents,’ including children, disabled people, and older adults. But the devaluation of care work depends on the social status of those who are being cared for (Calasanti, 2006). The theory of age relations, with its emphasis on relational inequalities between and among members of different age groups, helps to explain why some forms of care are more highly valued than others. Because youth is regarded as a transitional status with such positive attributes as “ ‘hope’ or ‘future,’ ” (Calasanti, 2003, 208), childcare is often considered a generative task. By contrast care needs in later life are typically associated with physical decline, impairment, and weakness. These conditions present a permanent change in status and exclusion from previous activities rather than a temporary sick role from which one will emerge. Thus, older adults needing care are often viewed as a burden. The prevalence of debates regarding ways to minimize the economic and social costs of eldercare and the low status and of paid and unpaid caregiving for older adults are indicative of the inequalities among age groups that tend to disadvantage older adults and those caring for them.

Second, theorizing age relations brings into view the structured contexts that shape experiences of care.Social relations are structural in the sense that they frame people’s life course experiences and relationships with others. Theorizing age relations reminds us that the problems associated with later life cannot be solely attributed to physiological aging processes or to individual decisions made throughout the life course; rather, they emerge in socio-structural contexts. For example common understandings and responses to age are embedded in policies guiding the distribution of pension incomes and spending on health and social care. These policies have a very real impact on older adults’ experiences of giving and receiving care.

Third, theorizing age relations gives insight on the intersecting relations of advantage and disadvantage—including class, age, gender, and race/ethnicity— that frame caregiving and receiving. These relations do not completely determine people’s life chances, but they do frame the contexts in which individuals act and interact (McMullin, 2000). An important difference between age relations and other forms of inequality is that aging is a universal experience. All people who live long enough to grow old will experience the marginalization associated with later life in an ageist society (Calasanti, 2003). The extent of this marginalization varies, though, as it intersects with class, gender, and race/ethnicity relations occurring throughout the life course. A framework that accounts for intersecting relations of inequality helps to explain, for example, older adults’ differential access to care and involvement in caring relationships.

Theorizing age relations has much to contribute to critical understandings of later life care. Debates regarding the relative influence of structure and agency, however, point to the potential limits of age relations. This concept recognizes that individuals hold the capacity to exert agency in the context of structured social relations, but primarily emphasizes the structural conditions that disadvantage older adults. This focus on disadvantage might inadvertently contribute to older people’s powerlessness. To avoid this risk, age relations must be theorized from the standpoint of older adults’ everyday, lived experiences (King, 2006). Theorizing age relations in research on older adults’ experiences of giving and receiving care can shed light on a private setting in which relations of dependency, power, and control between and among members of different age groups are worked out.